Cataracts:
Frequently Asked Questions

Reviewed by Vance Thompson, MD, and Charles Slonim, MD

What exactly is a cataract?

A cataract is a cloudiness of the eye's natural lens, which lies between the front and back areas of the eye.

Are cataracts found only in older people?

About half of the population has a cataract by age 65, and nearly everyone over 75 has at least one. But in rare cases, infants can have congenital cataracts. These are usually related to the mother having German measles, chickenpox, or another infectious disease during pregnancy, but sometimes they are inherited.

My doctor says I have a cataract, but he wants to wait a while before removing it. Why?

A cataract usually starts very small and practically unnoticeable but grows gradually larger and cloudier. Your doctor is probably waiting until the cataract interferes significantly with your vision and your lifestyle.

You need to continue to visit your eye doctor regularly so the cataract's progress is monitored. Some cataracts never really reach the stage where they should be removed.

If your cataract is interfering with your vision to the point where it is unsafe to drive, or doing everyday tasks is difficult, then it's time to discuss surgery with your doctor.

Is cataract surgery serious?

All surgery involves some risk, so yes, it is serious. However, cataract surgery is the most commonly performed type of surgery in the United States. Many cataract surgeons have several thousand procedures under their belt. Choosing a surgeon with this much experience will reduce the risk of something going wrong.

How is a cataract removed?

A small incision is made into the eye. The surgeon will either remove the lens as is, or use ultrasound, a laser or surgical solution to break it up, and then remove it. The back membrane of the lens (called the posterior capsule) is left in place. Usually, a replacement lens (called an intraocular lens, or IOL) is inserted.

Occasionally, a doctor will perform intracapsular extraction; this is when both the lens and the membrane are removed, to ensure that the membrane itself won't eventually grow cloudy and interfere with vision. When the membrane becomes cloudy, or if any bits of remaining natural lens become cloudy, this is called a secondary cataract.

The problem with intracapsular extraction is that the membrane is no longer there to receive a replacement lens. Read more about what to expect if you have cataract surgery.

I've heard that lasers are sometimes involved?

YAG lasers are used in a later procedure to create a clear opening in the lens-containing membrane, if the membrane becomes cloudy in the months following the original cataract removal.

Also, "laser-assisted" cataract surgery does exist in a few U.S. centers. The technology is in its developmental stage and has not yet attained the popularity of non-laser cataract surgery techniques currently performed by the vast majority of cataract surgeons.

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My father had cataract surgery a few years ago, and he had to wear thick glasses afterward. Is this still necessary?

Nowadays, cataract patients who have intraocular lenses (IOLs) implanted during surgery may need reading glasses for close vision, but that's about it. In fact, with the newer multifocal and accommodating IOLs, even reading glasses are unnecessary.

People who don't receive IOLs wear contact lenses for distance vision, with reading glasses for close up. Or they may wear multifocal contact lenses for all distances. Rarely does anyone have to wear thick eyeglasses now.

How much does cataract surgery cost?

It varies from one doctor to the next; it also depends on the eyewear that is prescribed and the type of artificial lens (intraocular lens) used as a replacement.

Medicare and most health insurance plans will cover cataract surgery and ordinary intraocular lenses, but not the cost of premium artificial lenses that simultaneously correct vision at near, intermediate and distant ranges. These types of lenses can cost as much as $5,000 or more out-of-pocket for both eyes.

What are possible side effects of cataract surgery?

As with any surgery, pain, infection, swelling and bleeding are possible, but very few patients have serious problems or cataract surgery complications. Your surgeon may prescribe medications for these effects.

Retinal detachment also occurs in a few people. Be on the lookout for excessive pain, vision loss, or nausea, and report these symptoms to your eye surgeon immediately.

[Page updated December 2008]